Sam Ashworth-Hayes Sam Ashworth-Hayes

Why the NHS needs more bureaucrats

If the NHS’s cheerleaders and detractors can agree on one thing, it’s this: we need fewer backroom staff. If the health service’s doctors, nurses and cleaners are heroes, the pen-pushers, middle-men and legions of drab men in drab suits are sucking the vital lifeblood out of the NHS, while droning on about synergies in management. All this while claiming a salary that could have paid for another two nurses.

This debate has re-emerged after it was reported that almost half of all NHS staff are managers, administrators or unqualified assistants. Helen Whately, the care minister, spoke for many when she said she feels ‘strongly that the money we put into the NHS needs to go to frontline’. But she’s wrong: if there is one thing that would help make the NHS better, it’s more bureaucrats.

In fact, the health service needs far more back office staff. So do our police forces, and other vital public services. If you suggested to a supermarket that in order to improve service it let go of its logistics specialists in favour of more floor workers, you would get exceptionally short shrift once the laughing stopped. And you certainly wouldn’t blame the empty shelves on the staff in the store.

Why would you hire more doctors without making sure they had the support they need to do their work?

With policing and healthcare, there’s no good visual shorthand showing you that something’s gone wrong up the chain of production. All there is to see is a crowded waiting room, and clinical staff rushed off their feet. Assuming the issue is a shortage of frontline workers is a natural logical step. In reality, the problem is more often one of management.

The point that ‘fund the frontline’ misses is that the number of frontline staff hired isn’t the number of frontline workers available; if your police officers or doctors are spending four or five hours of their day managing the burden of administration, they aren’t available to respond to a burglary or treat a new patient.

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